Gynecomastia is enlargement of breast tissue in boys. Pubertal gynecomastia is a normal physiological change that may occur to some adolescent starting between the age 10-12 and peak at age 13-14. Gynecomastia is a specific term in the medical field as there are a few other conditions that mimic gynecomastia such as lipomastia where the fat tissue infiltrate the breast and is common in overweight and obese children/adolescent boys.

Other causes of breast enlargement in adolescent boys and men are breast cancer and breast cyst both which are very rare. Gynecomastia itself has other several causes besides the physiological pubertal gynecomastia. This condition develops due to imbalance between the testosterone and estrogen and progesterone hormones. Below are a few ways of how pubertal gynecomastia can be treated.

• Observation/Watchful Waiting

Waiting for pubertal gynecomastia to disappear on its own sounds, not like a treatment right? Yet this is a recommendation by many medical guidelines out there since pubertal gynecomastia have been shown to resolve naturally in 85% of cases within two years of the onset. Another advice that can be given to the growing adolescent boys facing this problem is to eat healthily and exercise frequently. By eating fewer fats, there will be less chance theoretically for the excess fats in the body to be turned into estrogen hormones. Exercise frequently also will boost testosterone production and may correct the hormonal imbalance.

However, watchful waiting has a risk for the developing breast tissue to become fibrotic (hard) after twelve months and hindering effective treatment of pubertal gynecomastia. Medical intervention in the forms of medications is thus indicated if the patient feels pain and tenderness at the breast or an embarrassment.

• Medical therapy

There are two classes of drugs that are mainly used in the treatment of gynecomastia and the suitability of the drugs need to match the patient’s history and adherence. Medical therapy also is advisable to be implemented before 12 months of the symptom onset that is before fibrotic changes can take place for effective treatment.

1. Selective Estrogen Receptor Modulator (SERM)

This is a class of drug that aims at the estrogen receptor of the breast tissue and is suitable for adolescent boys with severe or embarrassing pubertal gynecomastia. It is usually intended to be used for three months. Examples of SERM are the Tamoxifen and Raloxifene and they have been shown in clinical trials to be effective in reducing gynecomastia symptom in most adolescent boys.

1. Androgens therapy

Androgens therapy is the testosterone replacement therapy and is only useful for boys with hypogonadism (the inability of the body to produce testosterone hormone). However, it may worsen the gynecomastia problem in certain people due to the conversion of testosterone into estradiol (a form of estrogen).

3) Surgery

Surgery is the last resort for treating pubertal gynecomastia and is not recommended by many specialists to the adolescent boys unless they are having considerable discomfort, significant psychological distress, refractory to medical treatment or having fibrotic changes already. The surgery is also will need to wait until a considerable testicular size is achieved by adolescent boys because of the possibility of the recurrent gynecomastia after the surgery.

All in all, pubertal gynecomastia needs an expert evaluation to exclude other causes of gynecomastia and its mimic conditions. Book appointment by DoctorOnCall to seek specialist help for diagnosing and treating pubertal gynecomastia.